Healthcare Provider Details

I. General information

NPI: 1578186052
Provider Name (Legal Business Name): JAMIE L TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N DALLAS ST
PRINCETON IL
61356-1830
US

IV. Provider business mailing address

5 N DALLAS ST
PRINCETON IL
61356-1830
US

V. Phone/Fax

Practice location:
  • Phone: 773-343-3476
  • Fax:
Mailing address:
  • Phone: 773-343-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: